are dry ADEKs sufficient/useful? is low fat diet increasing problems?

First, we don't absorb 20 - 50% of the fat we consume. It's 20%, period.

Next, and of greater importance, I think you're making this far more complicated than it needs to be. We don't absorb fat well. At all. The instructions you are finding all over the internet are based on RNY needs, even if they say DS. Far too many surgeons don't bother to differentiate between the very different needs of these operations, and the nutritionists don't understand the DS at all. We have seen this many, many times.

If you don't supplement your fat soluble vitamins in a form you will absorb, you will be in a world of trouble. And ADEK's won't do the trick - they contain the right stuff, but so little of each as to be useless. You really need to take the dry A, D, and K. E - *****ally knows. You don't hear much about Vitamin E deficiency.

Major Mom gave you her example, I'll provide mine. For my first year post-op, I just used ADEK's. Hey, I didn't know any better! My D level dropped to something like 7. I began using the dry D 50,000 units/day and now my D is 55. And tha'ts with minimal sun exposure.

So no, I'm not blasting you, but I am saying that we've been living with and dealing with this concern for years now and we know what works and what doesn't.

Larra

Larra,

Respecting the experience of DSers is the reason I am posting the question on this board.  Some of you are using at least some fat-soluble vitamins (with good results), some none at all.  What I don't notice is anyone talking about vitamin levels as having a good range.  Most seem to have problems with getting up to the range.  Is there something preventing problems with having too high a level of these vitamins?  In normals taking mega doses for too long a time can, for some vitamins, cause malabsorbtion.  

Thanks to the comments of people here I've taken another look at what people describe as their own diet.  Yup, most of the healthy people more than a year out seem to be eating lots of fat.  Good to know.  Almost everyone (aside from those currently being chastised) knows to maintain a high protein intake due to malabsorbtion.  It is probably/hopefully because people are focused on talking about keeping the protein intake up, and keeping carbs low (for weight loss or to prevent noxious gas warfare destroying those around them), that there is little discussion about nutrient dense foods and getting vitamins and minerals from the diet.

I am curious if those of you eating nutrient dense foods--lots of colourfull veggies, legumes, calcium rich foods, complex carbs-- are experiencing AS MUCH of a problem maintaining vitamin levels?  I think I'll set up a new strand asking about this.  Most people don't talk about this and it may simply be that people don't feel the need to mention this (as I found out when asking if there were people who did not have problems with synthroid).

Cai

Most of us require in the neighborhood of 100 gr protein per day.  Some have had great results increasing this to 150 or even 200.  Very few are successful with less for a long period of time.  We can get away with anything on a daily basis, as long as it's a once in a while thing.

I'm lucky and can eat anything and nothing causes me problems.  But if I get in my protein every day(I despise the smell of the shakes), I don't have a lot of room for the quantities of those veggies/legumes etc I would need to be able to replace my vites.  We have to rely on pills because there's no way to get therapeutic amounts from the foods we eat.  A typical meal for me would be a big piece of meat followed by a couple bites of whatever else is being served.  I'm not perfect and I usually save my carbs for crap like desserts.  But honestly, carbs are a waste and not needed at all.  Read up on glycogenesis.  You can burn up a lot of calories forcing your body to convert proteins to sugar!   It's magic!

Many people on the DS and RNY boards are focused on restricting  carbs to alter metabolism.  It seems like an excellent short term strategy to promote fat rather than muscle loss, but doing this for more than a year at most is dangerous (from what I've read).  I can see that it must be hard to get in the nutrients with a smaller stomach.  Thanks for sharing your experience!

Oh...just so I have a better idea of how this works, how far post surgery are you?  Is your pouch 'mature' or is part of the problem likely to gett at least a bit better over the next year?

Thanks,

Cai 

PattyL can certainly respond for herself, but wanted to make a point here.  DSers do not have a pouch.  DSers have a normally functioning stomach that does not need to "mature".  It is one of the most wonderful things about the DS, IMO.

Oops on the pouch reference, no oops on the 'maturing' reference.  I've been learning about both the RNY and DS procedures and apologize for using the wrong term (pouch).  I understand that the stomach, although smaller and less acidic than previously, has relatively normal function and a normal pyloric valve.  This is one of the most important reasons I am considering DS; more stomach wall should allow a wider variety of medicines to work, and an acidic stomach appears essential for some of my meds (the ones I am not likely to get off due to the surgery) to take a form the body can use.

But maturing of the remaining stomach, I think, has relevance to the DS process.  The portion of stomach remaining stretches somewhat during the first year.  This meaning of maturing is the same as in RNY  Additionally, given that the gut adapts, mainly within the first year, so the remaining portions can absorb more nutrients or in different locations, I would assume the stomach adapts on some level.  If nothing else, the body would need to accommodate changes in flow of fluids due to sectioning/cutting away a portion of the stomach.  If the stomach is less acidic the body will need to adapt.

So I'll happily apologize for using the word pouch but, from what I have read and am learning from all of you, I still think the word maturing is appropriate.

Thanks for making me think this through.  The point came up earlier in this post, but you've hit the same important fact: much of the information out there is designed for RNY and finding solid, recent, and detailed information on the DS is problematic.

Thanks,

Cai

I'll take this one, too.  I'm 7 yrs post op, so my stomach has "matured", as you call it.  Yes, the stomach stretches significantly over time, but not anywhere near what it started as.  The average normal stomach is about the size of a football.  My fresh post-op 100cc stomach can now hold about 8oz.  I can enjoy a fairly light-to-normal portioned meal (I'm talking the suggested serving size that you think is insane right now).  I eat every couple of hours and can usually get all the protein my body needs with real food.  I do love veggies, but I can tell you that I don't eat enough to not need supplements.  My PCP, in fact, says that most of the population does NOT eat right and everyone should at least get a multivitamin.

Valerie,

I understand that most of the general population has a diet that does not provide them with enough of every vitamin and mineral.  I currently take a multivitamin, calcium, and vitamin D, even though I have a pretty nutritious diet.  It is hard for an adult woman to get her recommended calcium intake without swigging shots of milk all day with canned salmon chasers.  Recent evidence suggests most people (in Canada and the U.S.) do not get enough vitamin D from diet or sun exposure, to the extent that OHIP (Ontario health insurance) no longer covers routine testing for vitamin D deficiency.  It is simply assumed that normal people are deficient.  As a pasty-skinned red-head I have no intention of soaking up more sunlight than absolutely necessary.  SPF 40 is my friend.  Besides, this is Canada and getting enough skin to sun time would involve serious frostbite.  So I take vitamin D tablets twice a day.

I am certainly not suggesting anyone with a DS (or RNY for that matter) should not take vitamins.  Obviously it is a necessary part of life after surgery.  You need to commit to taking significant amounts of vitamins and minerals every day, for life.  The levels of vitamins and minerals you need to take are high due to changes in how you absorb and process substances.  Yes, your stomach size restricts you to dieticians' definition of normal sized meals. Yes, protein requirements come first and can account for a great deal of your intake.  And yes, what space is left is not going to let you get all your vitamins and minerals from food, even if your gut was not reworked.

But from everything I've read here and elsewhere I still think the best approach is to try to maximize the potential for getting vitamins from your diet as well as from your supplements.  The approaches are not incompatible, they are complementary.  Getting nutrients from both food and non-food sources is what you describe as your own diet.  

I just don't see how you are "taking this one, too."  We seem to be of the same mind on this subject.

Cai

What I'm saying is that you shouldn't even begin to assume that you can eat enough healthy foods to eliminate the need to take any supplements.  Even though I feel I eat a diet rich in veggies and proteins, my day still consists of 14 pills to make up for what my body doesn't absorb to maintain normal nutrition level.  This is very commonplace, and many take even more than I do.  

Fat is you friend!  DSer's only absorb 20% of all fat eaten.  It helps keep BM's on the moist side, but...too much can give you the runs! 

Each of us has to find our own level, as this is not a one rule fits all surgery!  It is truly customized to the individual!  All of us don't measure out the same, so it would be unrealistic to expect to have the same outcome doing the same thing as another DSer.

I think we all find our own levels of everything, within the typical parameters for all DSers.

BTW, pouch is a RNY term.  DSer's have fully functioning stomachs, though reduced in size.